The Effect of Nebulizer Position on Aerosolized Epoprostenol Delivery in an Adult Lung Model

Abstract

The greatest amount of mean epoprostenol deposition resulted with the nebulizer placed at the humidifier inlet or outlet in a ventilator with bias flow.

Wet-Side Breath-Enhanced Jet Nebulization: Controlling Drug Delivery During Mechanical Ventilation

“…Previous studies identified important factors that individually, and in combination, impact aerosol delivery, including the following: position in the ventilator circuit, [1][2][3][4] humidification, 2,[5][6][7][8] duty cycle, 6,7,9 bias flow, 1,5 nebulizer technology, 1,2,6,7,10,11 nebulizer driving pressure and flow, 5,12 internal ventilator valves, 13 device reliability, 14 fill volume, 4,15 and treatment time. 6,7 Output data from commercially available devices published in the literature, 1,2,5,8,[16][17][18][19][20][21] demonstrate that, with current technologies, dose delivery varies widely based on nebulizer technology and ventilator setting are summarized in Figure 1.…”

Factors Determining Continuous Infusion Aerosol Delivery During Mechanical Ventilation

“…The Anderson, et al, 9 study also reported nearly identical Mean Total Dose values for epoprostenol collected on the filter: 6,347 (±973) ng for the dry side versus 6,537 (±2,234) ng for the wet side of the humidifier. Based upon our Mass Balance data showing approximately 15% deposition in the humidifier due to dry side mounting, it could be expected that the Inhaled Mass for the Aerogen VMN would be higher with wet side mounting because no humidifier deposition would have occurred.…”

“…No maximum output rate is specified by the manufacturer although VMNs have been reported to function during continuous infusion aerosol delivery at output rates greater than 12 mL/h; e.g., 20.2 mL/h when pre-tested to ascertain maximum output. 9 While some Aerogen VMNs can apparently function reliably above 12 mL/h, knowing which would require clinicians to pre-test VMNs before use.…”

“…8 While the Aerogen Solo VMN appears to have largely displaced usage of jet nebulizers for continuous infusion aerosol delivery, only a single bench study has been published characterizing its delivery of inhaled aerosolized prostacyclin during mechanical ventilation in an adult lung model. 9 Recently, the i-AIRE Breath-Enhanced Jet Nebulizer (BEJN) (InspiRx, Inc., Somerset, New Jersey) has been developed and tested for adult mechanical ventilation. [10][11] Breath-enhanced jet nebulizer technology operates at a lower jet flow than typical jet nebulizers and has been found to be more efficient than conventional jet devices.…”

“…recent bench study by Anderson, et al,9 represents the only in vitro assessment of vibrating mesh technology for continuous infusion aerosol delivery in the literature. Using a single Aerogen SoloVMN, selected from a group of pre-tested nebulizers and confirmed to have an output of 20.2 mL/h, Anderson and colleagues sought to distinguish specific differences in aerosol delivery at 4 positions in the ventilator circuit.…”